| NPI | 1326143959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY TL4463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 16355) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-07-09 |